The primary aim of the proposed research is to measure the psychological impact of maternal serum alpha-fetoprotein (MSAFP) screening on women who have elevated MSAFP levels but who do not have infants with neural tube defects. The effects of screening on these women, their husbands or partners, and the mother-infant pairs will be studied by performing serial assessments of anxiety and maternal attitudes toward pregnancy during pregnancy and by performing assessments of anxiety, maternal-infant bonding and infant behavior during the first year of the infant's life. These measurements obtained on the experimental subjects will be compared with the same measurements obtained on control subjects who have normal MSAFP levels. A system of "peer group counselors" will be established and applied to a subgroup of women with elevated MSAFP levels in an attempt to determine whether or not such a system might be of benefit in alleviating anxiety engendered by the screening process. The peer group counselors will be women who have previously participated in the screening program and have had elevated MSAFP levels but have gone on to deliver normal infants. A second aim of the proposed research will be to determine whether or not infants born to mothers with two elevated MSAFP levels but a normal amniotic fluid AFP are different from infants born to mothers with normal MSAFP levels as evidenced by an increased rate of congenital malformation, growth retardation, or developmental disabilities. This will be accomplished by conducting physical examinations and developmental assessments on these infants and controls during the first year of life. The scientific disciplines involved in conducting the project will include genetics, psychology, pediatrics, and biostatistics. The issues addressed in this proposal relate directly to public health policy, since the results of studies of this nature may have significant bearing on whether or not MSAFP screening becomes widespread in this country.